News

HHS Announces 10 New States to Participate in the CCBHC Medicaid Demonstration Program

• On June 4, the U.S. Department of Health and Human Services (HHS) announced that 10 new states will be participating in the Certified Community Behavioral Health Clinic (CCBHC) Medicaid Demonstration program: Alabama, Illinois, Indiana, Iowa, Kansas, Maine, New Hampshire, New Mexico, Rhode Island, and Vermont. The program, administered by CMS in partnership with SAMHSA, provides states with funding to expand access to mental health and substance use services in alignment with President Biden’s Unity Agenda and other efforts to support the mental health and addiction crisis. CCBHCs are reimbursed at full cost for Medicaid covered services and offer a comprehensive range of services for mental health and substance use disorder including 24/7 crisis care, care coordination, and timely outpatient care. The new cohort joins eight states already in the demonstration program: Michigan, Missouri, Kentucky, Nevada, New Jersey, New York, Oklahoma, and Oregon. Future expansions include awarding CCBHC planning grants to fifteen states in early FY2025, which will assist in certifying clinics, establishing prospective payment systems for Medicaid reimbursable services, and preparing an application to participate in the four-year demonstration. The expansion notice is expected to be posted this summer. Ten new states will be able to join the program in FY2026, in alignment with the Bipartisan Safer Communities Act (BSCA), which grants HHS the authority to add 10 states every two years (CMS, June 4).

Biden Administration Introduces Heat and Health Tool to Help Communities Prepare for Extreme Heat and Heat-Related Illness

• The Biden Administration developed and launched a new tool, the Heat and Health Index (HHI), that includes support and resources to help communities keep their residents safe from the expanding effects of climate change, including extreme heat and heat-related illness. This is the first tool able to provide heat-health outcome data at the zip code level and combines historic temperature data with Emergency Medical Services (EMS) data on heat-related emergency responses from the prior three years. The tool uses existing heat resources to provide a complete look at the communities most at-risk for negative health outcomes from heat by using available data on community characteristics, including pre-existing health conditions, socio-demographic information, and characteristics of both the natural and built environments (HHS, May 31).

CMS Releases Medicare, Medicaid Enrollment Figures

• On May 31, CMS released the latest enrollment figures for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). As of February 2024, enrollment in Medicare increased by 69,037 from the last report to 67.1M. Medicaid enrollment decreased during the same period by 654,280, to 83.4M enrollees. Of that number, 7.1M are enrolled in CHIP. There are over 12M dually eligible individuals who are counted in both Medicare and Medicaid program totals. According to CMS, every state is currently resuming its regular process for renewals in Medicaid and CHIP (CMS, May 31).

CMS Issues its Second Request for Applications for the Enhanced Oncology Model

• CMS’ Innovation Center is requesting applications for a second cohort of participants in its Enhanced Oncology Model (EOM) and is extending the model for two years (through June 30, 2030), making higher payments and establishing a higher threshold for when a provider owes CMS a performance-based recoupment. CMS created the EOM in 2022 after incorporating findings from the Oncology Care Model that operated from 2016-2022. CMS stresses that the EOM aims to create transformation in oncology care by preserving or enhancing the quality of care for patients undergoing cancer treatment while lowering spending for Medicare fee-for-service. The application portal for the new cohort will open from July 1 through September 16, and state Medicaid agencies and Medicaid managed care organizations are among the list of payers eligible to apply for the model (Inside Health Policy, May 31).

Federal Litigation

SCAN Health Plan Wins Medicare Advantage Ratings Lawsuit

• On June 3, U.S. District Court for the District of Columbia Judge, Carl Nichols, ruled that CMS breached the Administrative Procedure Act while calculating SCAN’s Medicare Advantage star ratings last year. The lawsuit focused on a statistical update through the Tukey Outer Fence Outlier Deletion Method that was first announced in 2020 and whether the text of a preamble to a rule is legally binding. If officials determine that CMS must recalculate all scores for plan year 2024, the decision could have significant implications for other insurers and would likely impact a number of other health plan pending cases. It is also possible that the case will be appealed (Modern Healthcare, June 4).

Federal Regulation and Guidance

CMS Informs States on Renewal Process Practices

• On May 30, CMS issued State Health Official Letter (SHO) #24-002 to extend existing reporting of specific metrics included in the Unwinding Data Report, allowing CMS to continue identifying and addressing areas of noncompliance. Beginning in July, states will not be required to report on changes to the baseline data or pending Medicaid applications if they have successfully completed the unwinding process. However, every state will be required to continue submitting data relating to renewals and fair hearing outcomes in a new report, the Eligibility Processing Data Report. CMS believes this type of data is valuable in the monitoring of retention and disenrollment numbers while also mitigating burdens beneficiaries face. CMS stated that they plan to continue reporting renewals and related data publicly with no listed end date (Inside Health Policy, May 30).

Federal Studies and Reports

The Government Accountability Office Releases Report with Prior Authorization Recommendations for CMS

• According to a Government Accountability Office (GAO) report made public in May 2024, Medicaid managed care plans’ prior authorization decisions for children need additional oversight. In its recommendations, GAO has requested CMS provide clear guidelines for states to monitor Medicaid managed care plans’ prior authorization decisions, specifically for EPSDT services, claiming that inconsistent policies create confusion for providers and beneficiaries. GAO also wants CMS to clarify whether health plans can require prior authorization for services for which the state does not require it in the fee-for-service delivery system. While CMS is working with states to gather data on current oversight activities, a lobby representing over 150 managed care organizations is pushing back on the report and arguing that prior authorization is needed to protect patients from overutilization (Inside Health Policy, June 3).